By William A. Read
Death is not uncommon in mountaineering. Its cold fingers follow you into the rotten couloir. You see it above as you traverse below the cornice. And there it is below your line of shifting pins. Most certainly it stalks the incessant animation of an active Himalayan glacier. But is this not part of the satisfaction and ultimate splendour of climbing—perched on the abyss, daring the early intrusion of the inevitable—but robbing the Black Caress through cunning, skill and often incredible luck ? And all this in the most appalling of beautiful surroundings. This is adventure-life. But what of annihilation ? Seldom in climbing is such realistically contemplated and even more rarely has it actually occurred. This is meant for war, not calculated risk in pursuit of the essence of being. Yet the moment of cleavage of a cliff of blue ice thrust forward by the East Dhaulagiri glacier crossed the judged schedule of five skilled mountaineers and two Nepali Sherpas. The collapse of the wall sent a thunder of tumbling death into half the American Dhaulagiri Expedition, crushing and burying, searing the deep snow from the glacier down to bare ice, plunging over a 500-foot cliff and, far below, finally resting and refreezing.
This is annihilation.
But tragedy was on nobody's mind during the winter of 1968. The phenomenal organization abilities of Boyd Everett had been at work for several years planning a Himalayan expedition. Permission for K-2 was impossible. Malubiting was promised by Pakistan but internal political difficulties delayed final approval. At the last minute, with the Malubiting permit impasse dragging beyond his time-table but with an expedition planned, Boyd turned to Nepal and the recently lifted climbing moratorium. In only three weeks after submission of the application, Nepal granted Boyd Dhaulagiri I by the south-east ridge.
Through a huge effort plans were shifted from the Karakoram to Nepal, additional money was raised, equipment was obtained and personnel firmed. A well-staffed and equipped expedition left the United States the first few days of April. Although only wild hopes contemplated the summit, an extremely strong reconnaissance was anticipated laying the ground work for a big push in 1970.
The final personnel were Boyd Everett, Leader, Jeff Duenwald, Paul Gerhard, Vin Hoeman, Jim Janney, Jim Morrissey, m.d., A1 Read, Deputy Leader, Lou Reichardt and Bill Ross, m.d! Terry Bech, a Fulbright Scholar in Nepal, agreed to serve as transportation officer, and Nepal assigned Hari Das as our liaison officer. Both of these individuals are exceptional people and quickly became very much a part of the expedition. I am satisfied that few expeditions have had a liaison officer of the superb quality of Hari Das. The German expedition to Annapurna had already taken the majority of available Sherpas but with one exception we were able to secure fine men: Panboche Tensing, Pemba Phutar, Mingma Norbu (Sherpas), Phu Tare and Pernba Norbu (cooks), Ang Pasang (runner) and Phu Dorje II (Sirdar),
In spite of Pan American Airlines' two-week delay of our equipment in Delhi, and through Lou Reichardt's ability to secure oxygen in India, we left Kathmandu in two stages on a chartered DC-3 to Pokhara on 15 April. Phu Dorje'had arranged 60 Tibetan and 30 Nepali porters and all were waiting at the airport. Within hours the advance team of Read, Hoeman, Bech and Tensing were on their way, and the main party with 90 porters was moving north from Pokhara toward the Kali-Gandaki and Dhaulagiri.
The trek to the mountain defies description. The environs of Kathmandu with its temples, smells and meshing of cultures were fascinating beyond all expectations. But the back country filled us with a sense of awesome fantasy—Machhapuchare breaking from the torried jungle to its stark and frozen summit 20,000 feet above—the beautiful Nepali people, laughing, curious and delightfully friendly—the damp mist of the rainforest with waterfalls into ponds of rhododendrons. And finally Dhaulagiri, huge, isolated, a distorted pyramid of immense magnitude rising out of the Kali-Gandaki gorge at 3,000 feet to its summit of 26,811. The first sight of this perhaps most difficult of all 8,000-metre peaks was staggering. We had considered ourselves mentally prepared for such a mountain. But this was bigger, more savage and forbidding than our imaginations had conceived. But why should it be otherwise? These are the Himalayas.
With intense excitement we approached the flanks of the southeast ridge. The porter's cry of 4 Very hot, Sahib, very hot!' gave way to a worried chill as the conifers and grassy highlands vanished and the expedition touched the first licks of snow. The advance team established a Base Camp at 15,000 feet on the snout of the East Dhaulagiri glacier. The main party began its approach from the valley 6,000 feet below.
Then began the ablation.
By James Morrissey, m.d.
At 7 p.m. on 21 April, Vin Hoeman radioed from the newly established Base Camp at 15,000 feet that everyone was fine. Because of snow and dense cloud over the advance party had spent most of the day (21 April) in the tents. A1 Read, deputy leader, ate poorly confining himself to his sleeping-bag where he slept fitfully. The previous night, his first at fifteen thousand, he had talked in his sleep awakening the other men in the tent. On the evening of the 21st A1 complained of a persistent headache. He took several Darvon Compound and was somewhat relieved. He had developed a cough several days prior to reaching his present altitude and this now became annoyingly frequent. At midnight he asked for a few more Darvon to suppress the cough. This request is the last thing he remembers. For the next 32 hours he was unconscious. At 3 a.m. Vin Hoeman was awakened by a loud groaning from Al. Attempts to arouse A1 proved futile. Vin took his pulse-it was 160 per minute. His respiratory rate was measured at 60 per minute. They crushed several Diamox and tried to force them between his tightly clenched teeth but he gagged on them.
Recognizing that Al had developed far advanced pulmonary edema, Vin and Terry prepared to evacuate him by wrapping him in a tent which could be guided down the steep slopes and then waited until 7 a.m. for radio contact and further instructions. Vin felt that avalanche danger was great on the newly covered slopes below camp.
At 7 a.m. on 22 April, Vin reported that A1 was unconscious with pulmonary edema. He was instructed to start down immediately with all due caution. Meanwhile those engaged in meeting the medical needs of the village of Kalipani terminated their work and took off up the river in an attempt to intercept the porters and collect the required gear.
At 8 a.m. Mingma Norbu and a porter left the valley floor at 7,800 feet with 3,600 litres of oxygen and medical supplies. Two hours later they arrived at 13,000 feet and oxygen was administered at very high flow rates. At 11 a.m. Lou Reichardt and Jim Morrissey arrived. In the excitement the oxygen had been administered at a rate which proved extremely wasteful and shortly after one hour the tank was empty. This being the case we dragged him down another 500 vertical feet and after inserting a urinary catheter to empty his bladder instituted therapy which consisted of intravenous Decadron, a very potent agent to decrease swelling in the brain and intravenous ethycrinic acid (50 mg.), a rapid acting diuretic agent. Within minutes his urine output became brisk. The urine was run into an inflatable plastic splint, the most convenient and durable seated container available. It worked just fine until the tubing pulled loose during one of the frequent jolts on the carry down.
At first glance A1 was obviously gravely ill. His colour was ashen ; his eyes bulged causing the lids to retract. He had assumed a decorticate posture and an indication of obliteration of neural communication between the brain and spinal cord. His pulse and respiratory rate respectively were still 160 and 60 per minute. He did not respond to painful stimuli. His conjunctivae were suffused and his pupils unequal (the right larger than the left). His neck veins were distended and a gurgling sound was audible when he inspired. On examination of his chest the lungs displayed the classical findings of pulmonary edema. Neurologic examination confirmed the impression that there was swelling and increased pressure in the brain.
After infusion with Decadron and ethycrinic acid we dragged him down to 12,400 feet where he was given oxygen by mask at 6 litres per minute for over two hours. His severe cerebral condition appeared to improve somewhat, so at 4 p.m. the decision was made to evacuate him to the lowest possible altitude before dark. Nearly a foot of snow had fallen during the afternoon making the attempt more hazardous but three exhausting treacherous hours later we pitched the tent, within which he had been wrapped, at 10,300 feet. The physician spent the night with him administering oxygen almost continually. At 2 a.m. he was given Decadron (2 c.c.) and ethycrinic acid (25 mg.) because his pulse and respirations, which had dropped considerably in the previous eight hours, rose again to 160 and 60 respectively.
By 5 a.m. on 23 April he answered questions with some accuracy though his answers were brief. He repeated his name and moved both upper extremities voluntarily, but could not carry out sophisticated moves. He could not move his legs and neurologic examination still showed a conduction defect between his brain and the lower spinal cord. By 6.30 a.m. he swallowed sips of water. His pulse was now 145 and respiratory rate 40-1.
At 8 a.m. he was dragged out into the open and shown a yak which was grazing nearby. This was the first memorable incident in 33 hours. By 9 a.m. he sat up without assistance and mentioned that his vision was obscured in his right eye, describing the deficit as a large irregular brown blotch near the centre of his visual field, At 11 a.m. the Foley catheter was removed and he was started on oral Polycillin (250 mg. every six hours).
At noon we started the long trip down to Kalipani, the nearest village, still 2,500 vertical feet below. A1 could barely support himself and had very little control of his lower extremities. With the assistance of several local people the evacuation was completed in six hours. That evening at 7,800 feet his pulse was 130 and respiratory rate 30 per minute. His lungs sounded virtually unchanged from the previous night despite marked clinical improvement. Neurologic examination revealed return of normal thought processes with improvement in co-ordination of his upper extremities but a significant loss of strength and co-ordination in his legs. He still had a positive Babinski reflex which indicated a conduction defect between the brain and lower spinal cord. Of interest was the finding that he could not identify articles by touch when he had his eyes closed. For example, he was unable to determine the difference between a pencil and a coin. In neurologic terms this is called astereognosis. This phenomenon persisted through 25 April. Starting on the evening of 23 April he was given Furosamide (lasix), 40 milligrammes twice daily for three days.
By 25 April his lungs were clear and his pulse and respiratory rate were within normal limits. With gradually increasing exercise his co-ordination returned but he continued to suffer from profound weakness and decreased vision in his right eye, although the spot obscuring his vision had decreased in size. On 27 April he set out for Jomosom, 15 miles up the Kali-Gandaki Valley. He arrived the morning of the 28th. Approximately one week later he arrived m Kathmandu where a thorough ophthalmologic examination revealed a pale area in the retina of the right eye The ophthalmologist's opinion considered the pale area to be a secondary thrombosis (blockage) of one of the branches of the retinal artery perhaps brought about by the tremendous pressure exerted on the vessel as it leaves the skull through a small opening An ophthalmologist here in the United States felt it was due to a viral infection, but the temporal relationship between the cerebral edema and visual loss make this impression highly suspect unless a viral illness contributed to the syndrome from the very beginning. This is not completely out of the question. Upper respiratory infections afflicted all of the members of the expedition at some time or other.
The development of pulmonary edema by A1 Read is remarkable for a host of reasons. He had climbed above 20,000 feet previously and experienced little difficulty. He had lived at 6 000 feet and worked at 8,000 during the months just prior to our departure for Nepal. In the ascent to 15,000 feet he had not gamed altitude exceptionally fast and had packed in over a 9,000- foot pass en route to the glacier. Admittedly the advance team had been pushing to get an acclimatization or Base Camp established, but not at high altitude. When they did get to 15,000 feet he spent the first 24 hours at rest, a practice which usually prevents severe edema.
In summing up the following points might be made:
First and foremost, all members of a party must be cognizant of the early signs of acute mountain sickness and be quick to bring suspicious symptoms to the attention of the entire group. The 4 it could not be happening to me' philosophy is dangerous not only to the individual afflicted but to the remainder of the party as well.
Ethycrinic acid (Edecrin) is an extremely effective diuretic in the emergency treatment of pulmonary and cerebral edema and may be as good as Furosamide (lasix) when taken orally as a prophylactic measure. According to Singh the gastrointestinal side effects make Edecrin inferior to lasix when taken by mouth.
To date the author is unaware of a report of ethycrinic acid being used for the treatment of acute mountain sickness. In view of the results of this case report it bears further evaluation.
The reader may be interested to know that A1 Read returned to his post as Chief Guide of the Exam Guide Service in Moose, Wyoming, last June and spent a productive summer instructing neophyte mountaineers. Aside from a very slight visual deficit in one eye he has no residual effect from his grave illness.
By Lou Reichardt
We both felt that we were finally in our element. The unfamiliar world of Nepal—temples, customs and intestinal ailments- lay 8,000 feet below. While we enjoyed the land and its hospitable people, it was the mountains which had lured us half-way around the world. Then, just as we reached them, Al had had to be evacuated. Those tense moments were also behind us. Vin and I were alone in a tent at 15,000 feet on the ice of the East Dhaulagiri glacier, trading tales of endurance and privation from past expeditions. A few hours before, the whole expedition had carried loads to this camp and had left us with a monstrous cache in a gentle snow-storm. In the morning, we were to climb higher to explore a route to the top of Dhaulagiri's east ridge. This afternoon and evening, though, we had time to talk, monitor our pulses as indexes of our acclimatization, and read.
The following day proved to be a hard one for me. Vin had brought an adhesive pair of snow-shoes, while I had only crampons. We spent several hours in an unequal battle against the snow on the lower part of the glacier, Vin walking easily while I thrashed along behind. Finally, the terrain steepened, and the snow-shoes had to be abandoned. The battle became a shared one, as we climbed to 17,000 feet encountering few technical difficulties. We returned to camp convinced that 4 easy' altitude could be gained on the glacier before attacking the ridge. On the following day, joined by Paul, we went 500 feet higher to the elevation at which we intended to leave the glacier. To our left was a rare break in the bank of rock created by the glacier's attack on the ridge. A spur of rock and snow led from above this chute to 20,000 feet, technically a moderately easy route. A large crevasse cleft our route on the glacier, though, at the lower rim of a huge basin that we would have to cross to reach the chute. We could see there were no obstacles in the basin. To forge a route which could be followed easily, we sent down a request for logs to Boyd and spent another evening at 15,000 feet monitoring pulses and expectations.
Joined in the morning by Pemba Phutar and Tensing, we carried a small tent, food, and climbing equipment to the edge of the crevasse. Vin and I had intended to remain there that evening and to explore further in the morning, but when we descended in the afternoon to collect the logs, we learned that they would not arrive that day. Boyd, Dave and Bill were occupying our old camp. To this point, they had been working hard with the others carrying loads to this height. Now they wanted to see the route. Boyd thought it might be easier to leave the glacier immediately and gain our elevation on the ridge. We decided to spend the night together-an evening transformed by the many taped symphonies Boyd had brought with him. Our camp became ‘Base Campa,’ psychological change that seemed destined to be repeated as we moved up the mountain
Bill and I had to wait in the inorning for Mingma to bring the logs from below. Then, with them balanced on top of my Kelty, we set out after the others. Sunshine and companionship conspired to make a relaxing morning. The pace was slow, and friendships were being renewed in this first large sortie on Alpine terrain. Still, the 12-foot logs made a strange load, frequently threatening my balance, on what already seemed a curious day, one in which we were carrying loads up a route that might be abandoned. I, at least, knew that the logs could be abandoned with the route. After mentioning this to Bill, he replied: 1 think we are committed to something up here.'
‘Quick! Let's get the logs across, so Boyd can cross without taking off his pack.' Bill and I had reached the crevasse a few minutes before the others, but it took time to properly rig the ropes. Everyone had time to arrive and unload. They stayed to inspect the proposed route. Encouraged, they remained to kibbitz. Then an afternoon fog descended upon us. A few minutes later, just as Bill and Vin were finishing the delicate pivoting of the timbers to the crevasse's far rim, a roar entered our consciousnesses. Neutral for a moment, it quickly posed a threat. We had only an instant to seek shelter before it consumed our world.
I found only a change of slope in the glacier for shelter and was repeatedly struck on my back with debris—all glancing blows which did not dislodge my hands. When it was finally over, assuming that it was snow that had been unable to bury us, I stood up fully expecting to be surrounded by the same seven companions. Instead, everything that was familiar—friends, equipment, even the snow on which we had been standing—was gone! There was only dirty, hard glacial ice with dozens of fresh gouges and scattered huge ice blocks, the grit of the avalanche. It was a scene painted in white of indescribable violence, reminiscent of the first aeons of creation, when a still molten earth was forged ; and at the same time it was uncannily silent and peaceful on a warm, misty afternoon. A triangular" cliff of ice, thrust out of the glacier by some invisible band of rock, had collapsed and the resulting debris had cut a 100-foot wide swath across the broad basin, filled the crevasse and overwhelmed us.
Yells of reassurance became expressions of my disbelief. A systematic search down the slopes revealed little above a high cliff and convinced me that everything had been carried over it, X spent an hour in this search and in a less thorough one of the debris below—a period of time allotted as a compromise between the conflicting demands for immediate rescue and for summoning people and equipment to help. Then I made the loneliest of trips down the glacier and rock to the 12,000-foot acclimatization camp, shedding crampons, overboots and, finally, even disbelief on the way. I returned with equipment and people to make a more thorough search of debris, but with no success. Probes were useless ; even ice-axes could not penetrate the huge ice mass, roughly the size of a football-field and 20 feet deep. We had no rational basis for hope. The avalanche was ice, not snow. The few items of equipment found were completely shredded. No man could have survived a ride in such debris.
We spent another week on the mountain retrieving equipment, not so much for its value but because of our reluctance to sever bonds with the past. Much in each of us died that day, and time spent alone with memories of past hopes, exertions and companionship seemed necessary then and appropriate later. 1 remember them now as my closest climbing companions—men who believed in testing their own limits and who enriched the lives of their friends by sharing their experiences and motives, men who died enjoying their avocation in a place they might have chosen.